title: Emergency department crowding and time to antibiotic administration in febrile infants.
abstract: BACKGROUND
  Early antibiotic administration is recommended in newborns presenting with febrile illness to emergency departments (ED) to avert the sequelae of serious bacterial infection. Although ED crowding has been associated with delays in antibiotic administration in a dedicated pediatric ED, the majority of children that receive emergency medical care in the United States present to EDs that treat both adult and pediatric emergencies. The purpose of this study was to examine the relationship between time to antibiotic administration in febrile newborns and crowding in a general ED serving both an adult and pediatric population.
  
  
  METHODS
  We conducted a retrospective chart review of 159 newborns presenting to a general ED between 2005 and 2011 and analyzed the association between time to antibiotic administration and ED occupancy rate at the time of, prior to, and following infant presentation to the ED.
  
  
  RESULTS
  We observed delayed and variable time to antibiotic administration and found no association between time to antibiotic administration and occupancy rate prior to, at the time of, or following infant presentation (p>0.05). ED time to antibiotic administration was not associated with hospital length of stay, and there was no inpatient mortality.
  
  
  CONCLUSIONS
  Delayed and highly variable time to antibiotic treatment in febrile newborns was common but unrelated to ED crowding in the general ED study site. Guidelines for time to antibiotic administration in this population may reduce variability in ED practice patterns.
authors.affiliation: University of Florida, College of Medicine, Department of Emergency Medicine Gainesville, Florida.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Light
authors.forename: Robyn M
authors.initials: RM
authors.lastname: Hoelle
authors.forename: Jill Boylston
authors.initials: JB
authors.lastname: Herndon
authors.forename: Wei
authors.initials: W
authors.lastname: Hou
authors.forename: Marie-Carmelle
authors.initials: MC
authors.lastname: Elie
authors.forename: Kelly
authors.initials: K
authors.lastname: Jackman
authors.forename: J Adrian
authors.initials: JA
authors.lastname: Tyndall
authors.forename: Donna L
authors.initials: DL
authors.lastname: Carden